Federal Activities & Agencies

Improving Health Outcomes, Preventing New Infections

HIV is a virus that can multiply quickly and damage the body’s immune system, making it hard to fight off infections and cancers. While no cure exists for HIV infection, effective treatment is available. Today, there are more than 30 antiretroviral drugs approved by the Food and Drug Administration (FDA) to treat HIV infection. When used consistently, antiretroviral therapy (ART) can reduce the amount of virus in the blood and body fluids to very low or undetectable levels (known as viral suppression). As a result, people living with HIV who start ART early, remain on treatment, and achieve and maintain viral suppression can stay healthy and live a near-normal lifespan. Treatment also confers enormous prevention benefits—in research studies conducted to date, no case of HIV transmission has been linked to someone who had a suppressed viral load. U.S. clinical guidelines recommend that all people who are diagnosed with HIV receive treatment, regardless of how long they have had the virus or how healthy they are.

Timely and Accessible HIV Treatment: A Critical Need

While the health and prevention benefits of ART are clear, only 54.7 percent of people living in the United States with diagnosed HIV infection are virally suppressed. Among those who do not have the virus in check, many have been diagnosed, but are no longer in care for a variety of reasons, including the cost of medical care and HIV drugs, stigma, shame, perceived or real concerns about taking HIV medications, lack of stable housing, and transportation. When people with HIV do not receive the treatment and care they need, the disease worsens and eventually progresses to AIDS. Today, nearly 13,000 people with AIDS in the United States die each year. People with HIV who have not achieved viral suppression also remain at risk of transmitting the virus to others. CDC has found that more than 90 percent of new HIV infections could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing care and treatment.

Disparities in HIV Treatment and Care

There are numerous disparities in HIV treatment and care among certain subpopulations in the U.S. For example, CDC’s report on monitoring indicates that African Americans living with diagnosed HIV infection have percentages of linkage to care and viral suppression that are lower than whites and far below national goals. Fewer people living with HIV in the South are aware of their infection than in any other region. Consequently, fewer people in the South who are living with HIV receive timely medical care or treatment, and fewer have their virus suppressed. Data from clinics funded by the Ryan White HIV/AIDS Program show that in that program, the viral suppression rates were lower among transgender women, youth between the ages of 13 to 24, and persons who were unstably housed. In that program, sizable disparities associated only with race or ethnicity were not observed, perhaps because of the comprehensive services provided. These populations have lower rates of engagement at each stage of care, due in part to a range of social and environmental conditions that make it more difficult to seek and stay in care. These conditions include poverty, poor access to health care, stigma, and a limited understanding of the benefits of treatment.

The scientific data showing the benefits of early HIV treatment for health of people living with HIV and prevention informed the National HIV/AIDS Strategy: Updated to 2020. The Strategy calls for a concerted national effort to improve health outcomes for people living with HIV by establishing seamless systems to link people to treatment and care immediately after diagnosis. The Strategy also calls for efforts to support maintenance in care; increase the capacity of health and social support systems; and increase the number and diversity of professionals who provide clinical care and related services to those with HIV. Further, the Strategy supports comprehensive, patient-centered care for people living with HIV, including addressing co-occurring health conditions and challenges in meeting basic needs, such as housing, which can cause individuals to leave care and treatment.

Measuring Progress: Improving the Health of People with HIV

By 2020, the Strategy aims to increase the percentage of newly diagnosed persons linked to HIV medical care within one month of their HIV diagnosis to at least 85 percent; increase the percentage of persons with diagnosed HIV infection who are retained in HIV medical care by at least 90 percent; and increase the percentage of persons with diagnosed HIV infection who are virally suppressed to at least 80 percent. Further, the Strategy’s targets include reducing the percentage of persons in HIV medical care who are homeless to no more than 5 percent, and reducing the death rate among persons with diagnosed HIV infection by at least 33 percent.

Across the Federal government, agencies are working to implement the Strategy and help close the gaps in HIV care and treatment for people living with HIV so that we can attain the healthier future that is within our grasp. This includes efforts focused on continuing to improve the response to HIV among racial and ethnic minority groups that have been hit hardest by HIV. An important resource to improve HHS agencies and offices’ ability to improve HIV-related outcomes and reduce HIV-related disparities among racial and ethnic minority communities is the Minority AIDS Initiative (MAI), which was established by Congress in 1999. The legislation allocates MAI resources to the CDC, HRSA, SAMHSA and the HHS Secretary’s Minority AIDS Initiative Fund (SMAIF). Resources awarded to HHS agencies support the delivery of services that are designed to complement, not duplicate, those supported by other funding. Two of areas of special emphasis of the MAI are building capacity of community-based organizations and improving the quality of care. The SMAIF plays a unique role in improving the quality of prevention and care for racial and ethnic minorities. SMAIF supports cross-agency demonstrations and agency-administered projects that serve as laboratories of innovation, testing out new approaches before innovations are introduced more broadly across prevention, testing, or care systems. The work includes evaluating how efficiency and quality of services can be improved to better serve people who need HIV services. Current SMAIF-supported demonstration projects are helping health departments and clinics re-engage individuals who are no longer in HIV care; enhancing clinical capacity to treat hepatitis C co-infection, one of the most common coinfections among people living with HIV in the U.S.; and building HIV care capacity in metropolitan communities in the South. The successes generated from SMAIF activities create lasting changes across the Federal HIV prevention and care portfolio, improving efficiency, further reducing HIV infection, and saving lives and health care dollars.

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Federal agencies play a variety of roles in supporting HIV care and treatment for people living with HIV in the United States. Some deliver HIV clinical services, others help pay for HIV care and treatment, while others provide housing, training, employment, or income supports that assist people living with HIV to remain in care and adherent to their treatment. Other federal agencies are involved in ensuring the safety and effectiveness of drugs and diagnostic tests used in HIV treatment while still others are engaged in setting, reviewing, and updating national guidelines for treatment of HIV disease and related issues.

Scroll down to read about the HIV care and treatment activities of individual agencies and offices.

Federal Agencies' Treatment Activities

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC), part of the U.S. Department of Health and Human Services, works 24/7 to protect America from health, safety, and security threats. CDC provides leadership in helping control the HIV/AIDS epidemic by working with community, state, national, and international partners in surveillance, research, prevention, and evaluation activities, as well as by working to improve treatment and support for people living with HIV.

While CDC does not deliver HIV care and treatment services, it conducts and supports numerous activities related to HIV care and treatment activities, including:

Supporting state and local jurisdictions in utilizing Data to Care, a public health strategy that uses HIV surveillance data to identify HIV-diagnosed individuals who are not in care, link them to care, and support them along the HIV care continuum.

Implementing demonstration projects such as Care and Prevention in the United States (CAPUS), a 3-year cross-agency demonstration project to increase the proportion of racial and ethnic minorities with HIV who have diagnosed infection and help link, retain, and re-engage them in care and prevention services; and the Partnerships for Care (P4C), a 3-year cross-HHS project funded through the Secretary’s Minority AIDS Initiative Fund (SMAIF) to build sustainable partnerships among CDC-funded state health departments and HRSA-funded health centers to support expanded HIV service delivery in communities highly affected by HIV, especially among racial/ethnic minorities.

Providing e-learning opportunities about medication adherence for clinical and non-clinical providers as well as a consumer smartphone app, Every Dose, Every Day, for people living with HIV. The app helps track adherence, viral load, and CD4 cell counts; provides dose and appointment reminders and tips for health and wellness; and features opportunities to record missed doses and medication side effects.

Supporting public awareness campaigns such as the Act Against AIDS campaign, HIV Treatment Works, which encourages people living with HIV to get in care, stay in care and live well.

Conducting a comprehensive program of HIV surveillance to collect, analyze, and disseminate data on HIV infection that supports monitoring trends at the state and national levels as well as the impact of national strategies on decreasing HIV incidence, improving linkage to care, and reducing disparities. HIV case surveillance data include information on demographic characteristics (i.e., sex, race/ethnicity, age, and place of diagnosis), transmission category (mode of exposure), initial immune status, and viral load. In addition, HIV case surveillance activities allow jurisdictions to monitor HIV disease progression and utilization of care services through the ongoing collection of data on laboratory test results (viral load and CD4 counts), opportunistic infections and illnesses, and vital status. Supplemental surveillance activities examine clinical and behavioral outcomes among adults receiving medical care for HIV infection in the United States.

Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, ensures effective, up-to-date health care coverage and promotes quality care for beneficiaries. CMS is the largest payer for the healthcare coverage of low-income people living with HIV in the United Sates.

Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. States manage the Medicaid program, and each state decides who is eligible and what the program covers. Some states have expanded their Medicaid programs to cover all people below certain income levels. Medicaid is currently the biggest source of insurance coverage for people living with HIV.

Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. It accounts for approximately one quarter of federal spending on HIV/AIDS care in the U.S. and is an important source of coverage for people living with HIV. All Medicare drug plans cover all HIV medications.

CMS is also charged with helping implement many reforms of the Affordable Care Act, the law that was passed to help ensure that Americans have secure, stable, and affordable health insurance. The ACA helped expand access to coverage for people living with HIV and other chronic health conditions.

Department of Defense

The mission of the U.S. Department of Defense (DoD) is to provide the military forces needed to deter war and to protect the security of our country. Within the DoD, the Military Health System weaves together health care delivery, medical education, public health, private sector partnerships, and cutting edge medical research and development. All DoD beneficiaries served by the Military Health System have access to quality HIV care and treatment, and support to attain the best possible outcome in living with HIV. DoD HIV clinical services are consistent with national guidelines and include comprehensive screening, surveillance, health education, and treatment with antiretroviral therapy. In addition, the Military Health System has many patient-centered care initiatives such as complex care coordination and patient-centered medical homes, which help improve the health and well-being of all beneficiaries, including individuals with HIV.

U.S. Department of Education

The U.S. Department of Education’s (ED) mission is to promote student achievement and preparation for global competitiveness by fostering educational excellence and ensuring equal access.

ED’s Rehabilitation Services Administration supports the development and implementation of comprehensive and coordinated state programs of vocational rehabilitation and supported employment for individuals with disabilities, including people living with HIV, through services, training and economic opportunities, in order to maximize their employability, independence and integration into the workplace and the community. RSA works to facilitate nationwide HIV prevention training for state vocational rehabilitation and special education programs.

Food and Drug Administration

The Food and Drug Administration (FDA), an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products, and medical devices. FDA is also responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off radiation, and for regulating tobacco products.

While FDA doesn’t deliver or pay for HIV care, it plays a vital role in making HIV treatment possible. FDA responsibilities include playing a review and oversight role related to drugs, biologics, and medical devices for the prevention, diagnosis, and treatment of HIV/AIDS, and AIDS-related conditions. This includes assuring that diagnostic and screening tests for HIV are sensitive and specific for the detection and/or quantification of HIV in blood and other body fluids, and conducting regulatory research to establish product standards and develop improved testing methods to assess the safety of drugs and biologics. FDA also oversees the nation’s blood supply, to ensure that blood and blood products are as safe as possible, and oversees the development of vaccines, including those being studied to prevent HIV infection.

Health Resources and Services Administration

The U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) is the primary Federal agency for improving health and achieving health equity through access to quality services, a skilled health workforce, and innovative programs. HRSA's programs provide health care to people who are geographically isolated, and economically or medically vulnerable.

HRSA’s HIV/AIDS Bureau (HAB) administers The Ryan White HIV/AIDS Program (RWHAP), the largest Federal program focused exclusively on providing HIV care and treatment. The program provides a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured. The Program works with cities, states and local community-based organizations to provide HIV care and treatment services to more than 512,000 people each year. Find a Ryan White HIV/AIDS Medical Care Provider.

The majority of RWHAP funds support primary medical care and essential support services for people living with HIV. A smaller but equally critical portion is used to fund technical assistance, clinical training, and the development of innovative models of care. The Program serves as an important source of ongoing access to HIV medication that can enable people living with HIV to live close to normal lifespans.

HRSA’s Bureau of Primary Health Care (BPHC) funds a network of Health Centers in every state that provide high quality preventive and primary health care to patients in underserved communities, regardless of their ability to pay. Approximately 1 in 14 people in the U.S. rely on a HRSA-funded health center for medical care. HRSA Health Centers provide a full range of services to promote health and diagnose and treat disease. All Health Centers offer HIV testing. Some patients with HIV receive treatment and care at the Center itself, while others are referred to HIV specialists. Find a HRSA Health Center.

HRSA’s Bureau of Health Workforce (BHW) improves the health of underserved and vulnerable populations by strengthening the health workforce and connecting skilled professionals to communities in need.

Learn more about HRSA’s efforts to support the care and treatment of people living with HIV/AIDS.

U.S. Department of Housing and Urban Development

The mission of the U.S. Department of Housing and Urban Development (HUD) is to create strong, sustainable, inclusive communities and quality affordable homes for all. HUD works to strengthen the housing market to bolster the economy and protect consumers; meet the need for quality affordable rental homes; utilize housing as a platform for improving quality of life; build inclusive and sustainable communities free from discrimination; and transform the way HUD does business.

HUD’s Office of HIV/AIDS Housing manages the Housing Opportunities for Persons With AIDS (HOPWA) program. The HOPWA program is the only Federal program dedicated to the housing needs of people living with HIV/AIDS and their families. Under the HOPWA Program, HUD makes grants to local communities, states, and nonprofit organizations for projects that benefit low-income persons living with HIV/AIDS and their families. With safe, affordable, decent housing, people living with HIV/AIDS are better able to access comprehensive health care and supportive services, get on HIV treatment, take their HV medication consistently, and see their health care provider regularly.

As part of their ongoing efforts to support people living with HIV, HUD also collaborated with the Department of Labor to launch Getting to Work, a training curriculum to assist service providers in understanding HIV/AIDS in the context of employment and the different approaches to helping clients who are ready to work identify and achieve their related goals.

Indian Health Service

The U.S. Department of Health and Human Services’ Indian Health Service (IHS) is responsible for providing comprehensive federal health services to American Indians and Alaska Natives (AI/AN). IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level.

IHS’ National HIV/AIDS Program coordinates and promotes HIV/AIDS prevention and treatment activities specific to AI/AN people as part of a comprehensive public health approach. The goals of the HIV/AIDS Program are to prevent further spread of HIV and to improve health outcomes for those already living with HIV. The program’s efforts include providing medical care to eligible beneficiaries, increasing access to care, and improving health outcomes for people living with HIV and AIDS. The program also provides technical assistance to Indian Tribes, Tribal organizations, and urban Indian organizations regarding HIV/AIDS prevention and treatment programs.

National Institutes of Health

The National Institutes of Health (NIH), part of the U.S. Department of Health and Human Services, is the nation’s medical research agency—making important medical discoveries that improve health and save lives. NIH-funded scientists investigate ways to prevent disease and conduct research on both common and rare diseases to discover their causes, develop effective treatments, and find cures. NIH represents the largest and most significant public investment in HIV/AIDS research in the world. Almost all of the 27 NIH Institutes and Centers (ICs) conduct and support basic, clinical, behavioral, social science, and translational research that addresses the prevention and treatment of HIV disease and its associated coinfections, comorbidities, and other complications.

NIH’s Office of AIDS Research (OAR) coordinates the scientific, budgetary, legislative, and policy elements of the trans-NIH HIV/AIDS-related research program. OAR a component of the Division of Program Coordination, Planning, and Strategic Initiatives in the Office of the NIH Director, supports the development of up-to-date HHS guidelines for the treatment of HIV infection, and the prevention and treatment of HIV-associated opportunistic infections. The guidelines are developed and regularly updated by working groups of HIV experts from across the country, including physicians, other health care clinical providers, pharmacists, researchers, and HIV treatment advocates. These clinical guidelines outline the current science and recommendations for treatment of HIV disease (e.g., antiretroviral therapy, treatment, and prophylaxis for opportunistic infections) as well as guidelines for conducting HIV testing and counseling.

The expert working groups are under the auspices of the NIH Office of AIDS Research Advisory Council and develop HIV guidelines for:

Social Security Administration

The mission of the Social Security Administration (SSA) is to deliver Social Security services that meet the changing needs of the public. This includes the Supplemental Security Income (SSI) program, which is designed to provide financial support for people with disabilities and low income and resources. It also includes the Social Security Disability Insurance (SSDI) program, which provides benefits for people with disabilities who meet insured status by accruing a specified number of work credits through their payroll tax contributions. So while SSA does not provide or pay for HIV treatment services, some people with HIV/AIDS who cannot work may qualify for disability benefits from SSA. These benefits can help support an individual who is disabled by HIV/AIDS and help him or her remain in HIV care and on treatment.

The agency provides guidance to people living with HIV/AIDS and health professionals on Social Security programs that pertain to them and how to access them. On World AIDS Day 2OI6, SSA published a final rule revising HIV medical criteria for SSA’s disability determination. This is the first revision to the regulation since it was created in 1993. The final rules will remain in effect for three years.

Substance Abuse and Mental Health Services Administration

The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

While SAMHSA does not deliver or pay for HIV treatment, it works to ensure that individuals who are at high risk for or who have mental health and/or substance use disorders and who are at risk for or are living with HIV/AIDS have access to and receive appropriate behavioral health services, which better enable them to remain in ongoing HIV care and adhere to their HIV treatment plan. Many of its programs also support HIV testing and linkage to care for individuals diagnosed. In addition, many SAMHSA-funded grants support substance use treatment and HIV- and AIDS-related services for racial and ethnic minorities and other populations at high risk for HIV infection, including lesbian, gay, bisexual, and transgender individuals.

Department of Veterans Affairs

The Department of Veterans Affairs (VA) serves and honors the men and women who are America’s veterans. The VA is the largest single provider of medical care to people with HIV in the United States. VA's efforts in this area are led by the HIV, Hepatitis, and Human Pathogens Programs, under the direction of Patient Care Services whose mission is to provide the highest quality, comprehensive care to Veterans and to have that care recognized as the standard by which all health care in the United States is measured. This includes patient care activities, clinician and patient education, prevention activities, and research directed at continuous improvement of medical and preventive services and delivery of care to veterans.

VA’s HIV/AIDS efforts, carried out by VA medical facilities across the country, take a comprehensive approach that includes:

Many Federal agencies have developed public awareness and education campaigns to address HIV prevention, treatment, care, and research. In this section, you’ll find a snapshot of these Federal HIV campaigns and links to help you access more information as well as campaign materials that you can use. Also included is information about campaigns related to the prevention and diagnosis of hepatitis B and C.

HIV.gov's Virtual Office Hours provides free social media technical assistance for the HIV community. Appointments are available for individuals or groups who want to learn how to best use social media for their HIV programs.